Wrongful Denial of Long-Term Care Insurance Benefits in California

When the insurance companies initially deny benefits, customers, which mostly consist of elderly people, are encouraged to fill out tedious and time-consuming paperwork, which they are often not capable of doing due to factors such as decreased cognitive ability, focus and memory. Undoubtedly, some insurance companies hope that the insured is unable to take proper legal action in response to the insurer’s bad faith denial of benefits. As a result, insurance companies will often get away with wrongfully denying  insurance benefit payouts. Then the person will have to pay hefty rates out of pocket in order to receive the care they need.

By failing to appropriately respond to a wrongful denial of long-term care insurance benefits, an elder sacrifices what was left of their assets, decreasing their comfort at the end of their life, and drastically reducing any sort of inheritance they had wished to pass on to their next of kin. After paying high insurance premiums for years, the elder deserves to be treated fairly and receive the insurance payout to which he or she is entitled. Unfortunately, there are numerous unscrupulous insurance companies who knowingly and wrongfully deny elderly persons’ requests for insurance benefit payouts simply because those insurers know they can get away with it if the elder is unwilling to take legal action.

Inevitably, certain health complications come along with aging. Sometimes these health issues can be quite serious and require long-term care. Long-term care insurance can be one of the best investments that folks purchase in their entire lives, as it can provide an elder with necessary long-term care without draining their finances. Long-term care insurance benefits can expand the duration of your life, and significantly enhance the quality of your life in your golden years. However, if the insurance company fails to act honestly and fulfill its obligations under the long-term care policy, what would have been a great investment turns into a horrible waste of money. Regrettably, many elders have discovered that long-term care insurance is much easier to invest in than to get money out of. Here are some steps that should and should not be taken when a long-term care insurance claim has been made, and you or your loved one feel as though the insurance company is acting in bad faith:

Do:

• Review your policy and become aware of its terms
• Ensure that your physician’s plan of care aligns with what is covered under your policy’s provisions
• Provide your insurance company with written certification from you or your loved one’s physician in order to demonstrate the necessity and appropriateness of the insurance coverage
• Keep track of all correspondence with the insurance company, and be sure to get the name and phone number of any agent that you speak with, especially if the correspondence is done orally.
• Send correspondence by mail so that it may be tracked and accounted for
• Keep a paper trail of all documents sent to and received from the insurance agent and insurance company
• Have a trusted friend or family member listen in on all of your phone calls with the insurance company, and document what was said by whom during that phone call.

Don't:

• Allow the insurance company or its agents to intimidate you
• Give up simply due to feeling overwhelmed or burdened with too much paperwork
• Allow the insurance company to do an evaluation to see if you meet certain qualifications without a family member or caregiver present
• Dismiss alternative care provisions
• Give up because the insurance company tells you that you are not covered or are otherwise not entitled to benefits under your long-term care insurance policy
• Trust the word of one agent, or the insurance company as a whole. They have the company’s best interest at heart, not yours or your loved one’s.